Clinical decision-making before discharge in hospitalized persons with schizophrenia: a Spanish Delphi expert consensus.

Introduction: The care of people with schizophrenia (PWS) is usually provided in an outpatient setting by community mental health teams. However, PWS frequently require inpatient treatment because of a wide array of clinical, personal and/or social situations. Unfortunately, to our knowledge, there are no guidelines available to help psychiatrists in the decision-making process on hospital discharge for PWS. The aim of this project was to develop an expert consensus on discharge criteria for PWS after their stay in an acute inpatient psychiatric unit. Methods: Using a modified Delphi method a group of 42 psychiatrists throughout Spain evaluated four areas of interest regarding this issue: clinical symptomatology, treatment-related factors, follow-up health care units after discharge, and physical health and monitoring. Results: After two rounds, among the 64 statements, a consensus was reached for 59 (92.2%) statements. In three (17.7%) of the 17 statements on 'clinical symptomatology' and 2 (13.3%) of the 15 statements on 'follow-up health care units after discharge', a consensus was not reached; in contrast, a consensus was reached for all statements concerning 'treatment-related factors' and those concerning 'physical health and monitoring'. The consensus results highlight the importance for discharge of the control of symptoms rather than their suppression during admission and of tolerability in the selection of anantipsychotic. Discussion: Although there is a lack of relevant data for guiding the discharge of PWS after hospitalization in an acute inpatient psychiatric unit, we expect that this consensus based on expert opinion may help clinicians to take appropriate decisions.

Reappraising personal values in cancer: Meaning-in-life adaptation, meaningfulness, and quality of life.

OBJECTIVE: This study explores the reappraisal of personal values among people with cancer post-diagnosis and its connections to meaningfulness, encompassing personal meaning and sense of meaning, and various dimensions of quality of life. METHODS: A total of 144 patients with diverse cancer types and a control group comprising 158 healthy adults with similar demographic characteristics completed the Valued Living Questionnaire-Perceived Change, the Personal Meaning Profile-Brief, the Portrait Values Questionnaire, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being. RESULTS: Cancer patients displayed a substantial values reappraisal compared to healthy adults. They reported an increased significance of social areas and self-transcendental values, including close relationships (family, partner, and friends), spirituality, citizenship, and universalism, as well as an increased importance of self-care and self in general. Conversely, cancer patients assigned less importance to work and self-enhancement values such as stimulation, power, and achievement. Cluster analysis revealed that patients who reappraised their values exhibited higher meaningfulness and better indicators of quality of life, including spiritual and physical well-being, compared to patients who did not modify their value system. CONCLUSIONS: These findings underscore the importance of assessing and promoting meaning-in-life adaptability among people with cancer, with potential applications in meaning-centered therapies and interventions aimed at enhancing psychological flexibility.

A Scoping Review of the Influence of Mindfulness on Men's Sexual Activity.

Mindfulness practice and mindfulness-based interventions are widely known, especially for women's sexuality. However, it is currently unknown how this practice affects the experience of male sexuality, possibly due to the existence of pharmacological treatments that are usually the first choice of treatment for men. The objectives of this study are to explore the influence of mindfulness on different components of men's sexuality from a scoping review of relevant scientific articles existing in the literature. A literature search from 2010 to 2022 was carried out in the electronic databases MEDLINE, Embase, PsycINFO, Web of Science, Scopus, PubMed, Dialnet, SciELO Citation Index, and Redalyc. Out of the 238 studies, 12 that met the defined selection criteria were selected. The analysis of these studies seems to indicate that the practice of mindfulness favours different variables of male sexuality, such as satisfaction and sexual functioning or genital self-image. Mindfulness-based interventions represent a valuable and promising contribution. No adverse effects were detected from the review of scientific articles considered in this work. Nevertheless, more randomized studies with active control groups are necessary to establish the benefits of mindfulness-based interventions in sex therapy for men.

Performance of a measure to assess distress in bipolar disorder.

INTRODUCTION: Bipolar disorder is a condition that causes distress even for euthymic patients, having an impact on functional capabilities and quality of life. Personal and social variables are potential sources of distress. Yet, there is a lack of measures to identify specific distress in bipolar disorder. This study describes the development and evaluation of a brief measure for assessing distress in patients with bipolar disorder. We also identify associations with related constructs such as functioning, stigma, and personal beliefs regarding mental illness. MATERIAL AND METHODS: We used a sample of 101 euthymic bipolar outpatients. Psychological assessment consisted of the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAM-D) to establish euthymia. Distress was assessed with Distress on Bipolar Patients-Short (DISBIP-S); associated variables were assessed with the Functioning Assessment Short Scale (FAST), the Internalized Stigma of Mental Illness (ISMI), and the Personal Beliefs about Illness Questionnaire (PBIQ). RESULTS: The DISBIP-S has strong internal consistency (Cronbach's alpha=0.90), and medium-high correlation coefficients with the time since last relapse (r=-0.401), predominant polarity (r=0.309), HDRS (r=-0.644), FAST (r=0.453), ISMI (r=0.789), and PBIQ (r=-0.796). Taken together, the scores on the ISMI, and PBIQ and the time since last relapse together explain 69.2% of the variability in distress. CONCLUSIONS: The DISBIP-S can be used as a first step to develop interventions aimed at dealing with problematic personal beliefs and interpersonal sources of distress. Reducing distress experienced by bipolar disorder patients could help improve their quality of life and daily functioning.

A preliminary exploration on psychological variables related to online social network addiction. / Exploración preliminar sobre las variables psicológicas implicadas en la adicción a redes sociales on-line.

This study examined the roles of anxiety, experiential avoidance and meaning in life in the abusive use of social networks. Participants in the study (N = 235: 172 women, 62 men, 1 non-binary) volunteered to complete a brief online survey measuring experiential avoidance, anxiety and meaning in life. Correlational and linear regression analyses were performed controlling for age in both the total sample and the subsamples of men and women. The partial correlation analyses showed that, once age was controlled for experiential avoidance, anxiety and meaning in life were related to the abusive use of social networks in women, while for men, only anxiety was significant. For women the linear regression equation which best predicted abusive use of social networks included little meaning in life and high experiential avoidance. For men, only anxiety was a possible predictive factor of abusive use of social networks. These results are discussed with regard to existing research on abusive use of social networks, noting the possible protective effect of meaning in life and calling greater attention to gender differences in behaviors related to online social networks.

El presente estudio examinó el papel de la ansiedad, la evitación experiencial y el sentido vital en el uso abusivo de redes sociales. Los participantes (N = 235: 172 mujeres, 62 hombres, 1 no-binario) completaron una breve encuesta dirigida a medir la evitación experiencial, la ansiedad y el sentido vital. Se llevaron a cabo análisis de regresión lineal y correlaciones controlando la influencia de la edad tanto para hombres como para mujeres. Los análisis de correlación parcial mostraron que, una vez controlada la edad de los participantes, tanto la evitación experiencial como la ansiedad y el sentido vital estuvieron relacionados con el uso abusivo de redes sociales en mujeres; sin embargo, para los varones, sólo la ansiedad se relacionó con un mayor uso de redes sociales. Para las mujeres la ecuación de regresión lineal que mejor predijo el uso abusivo de redes sociales incluyó un bajo sentido vital y una elevada evitación experiencial, mientras que para los varones sólo la ansiedad predijo el mayor uso de redes sociales. Los resultados obtenidos se discuten en relación con la investigación existente sobre el uso de las redes sociales, destacando el sentido vital como un posible factor protector y la importancia de una perspectiva de género para estudiar las redes sociales en línea.

An international study on psychological coping during COVID-19: Towards a meaning-centered coping style.

BACKGROUND/OBJECTIVE: This study examined the role of different psychological coping mechanisms in mental and physical health during the initial phases of the COVID-19 crisis with an emphasis on meaning-centered coping. METHOD: A total of 11,227 people from 30 countries across all continents participated in the study and completed measures of psychological distress (depression, stress, and anxiety), loneliness, well-being, and physical health, together with measures of problem-focused and emotion-focused coping, and a measure called the Meaning-centered Coping Scale (MCCS) that was developed in the present study. Validation analyses of the MCCS were performed in all countries, and data were assessed by multilevel modeling (MLM). RESULTS: The MCCS showed a robust one-factor structure in 30 countries with good test-retest, concurrent and divergent validity results. MLM analyses showed mixed results regarding emotion and problem-focused coping strategies. However, the MCCS was the strongest positive predictor of physical and mental health among all coping strategies, independently of demographic characteristics and country-level variables. CONCLUSIONS: The findings suggest that the MCCS is a valid measure to assess meaning-centered coping. The results also call for policies promoting effective coping to mitigate collective suffering during the pandemic.

ANTECEDENTES/OBJETIVO: Este estudio examinó el papel de diferentes estrategias de afrontamiento psicológico en la salud mental y física durante las fases iniciales de la crisis de COVID-19. MÉTODO: 11,227 personas de 30 países representando todos los continentes participaron en el estudio y completaron medidas de malestar psicológico (depresión, estrés y ansiedad), soledad, bienestar, salud física, medidas de afrontamiento centrado en el problema y en la emoción, y una medida denominada Escala del Afrontamiento Centrado en el Sentido (MCCS) que fue desarrollada en este estudio. El análisis de validación de la MCCS se realizó en todos los países, y los datos se evaluaron mediante un modelo multinivel. RESULTADOS: La MCCS mostró una estructura unifactorial en 30 países con buenos resultados de validez test-retest, concurrente y divergente. Los análisis mostraron resultados mixtos en cuanto a las estrategias de afrontamiento centradas en la emoción y en el problema. La MCCS fue el predictor positivo más fuerte de salud física y mental, independientemente de las características demográficas y las variables a nivel de país. CONCLUSIONES: Los resultados sugieren que la MCCS es un insrumento fiable para medir afrontamiento centrado en el sentido. Estos resultados pueden servir para dirigir políticas que promuevan un afrontamiento eficaz con el fin de mitigar el sufrimiento colectivo durante la pandemia.

Is "Self-Experience" Really a Transdiagnostic Concept? Preliminary Evidence in Favor of the Transdiagnostic Conception of Functional Analytic Psychotherapy.

Functional Analytic Psychotherapy (FAP) offers a radically behavioral and transdiagnostic conception of the formation of the "self" and the appearance of a diversity of psychological problems. This study examined the extent to which a wide variety of psychological disorders (somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility/aggressiveness, phobic anxiety, paranoid ideation, and psychoticism) and a global index of psychopathological severity may in fact be linked to problems of the "self" according to the FAP conception. Two questionnaires, one related to self-experience according to FAP and the other to find the scores on several different psychopathology scales, were administered to 280 adult Spaniards for this purpose. The results confirmed the transdiagnostic nature of the "self"-experience. There are significant and strong correlations between all the psychopathology scales studied and self-experience. Linear regression analyses also show that, along with age and gender, in some cases, the score on self-experience predicts each and every one of the psychopathological variables studied, in addition to the Global Severity Index. These results are discussed and related to the transdiagnostic approach to psychopathology.

Assessment Tool of Bipolar Disorder for Primary Health Care: The SAEBD.

Mixed states are highly prevalent in patients with bipolar disorder and require comprehensive scales. Considering this, the current study aims to develop a measure to assess the full spectrum of clinical manifestations of bipolar disorder. A sample of 88 patients was evaluated; the Hamilton Depression Scale (HAM-D), Montgomery-Asberg Depression Scale (MADRS), and the Young Mania Rating Scale (YMRS) were applied, together with the preliminary version of the Scale for the Assessment of Episodes in Bipolar Disorder (SAEBD). After analyzing the appropriateness and statistical properties of the items, discriminant analysis and analysis of diagnostic capacity were performed. The discriminant functions correctly classified 100% of the cases in euthymia, predominant depressive symptoms or mixed symptoms, as well as 92.3% of the cases with predominant manic symptoms. Overall, the functions correctly classified 98.9% of the cases. The area under the curve (0.935) showed high capacity to discriminate between clinical and non-clinical cases (i.e., in euthymia). The SAEBD sensitivity was 0.95, specificity was 0.71, the Positive Predictive Value (PPV) was 0.88, the Negative Predictive Value (NPV) was 0.87, the Positive Likelihood Ratio (+LR) was 3.33, and the Negative Likelihood Ratio (-LR) was 0.07. In conclusion, the SAEBD is a promising scale that shows high reliability and validity, as well as diagnostic utility as a screening tool for use in diverse health care settings.

Impact of the COVID-19 pandemic on acute inpatient psychiatric units in Spain.

Patients with more severe mental health symptoms are treated in acute inpatient psychiatric units (AIPUs), but the functioning of these units throughout Spain has been challenged by the COVID-19 pandemic. We therefore conducted a descriptive, cross-sectional study to assess the situation. An online survey was distributed to all hospitals with AIPUs in Spain and made accessible for 28 days. Two scientific coordinators were appointed to supervise the scientific and methodological aspects of the study. The most relevant findings include reductions in numbers of beds and staff, insufficient material resources, changes in action protocols and in admission processes, and limitations in routine therapies, such as group and occupational therapy, psychotherapy and psychoeducational programmes. The possibility of performing ECT was also seriously curtailed. This is the first study to evaluate the impact of the first wave of the COVID-19 pandemic on AIPUs. These data may help improve the quality of care of patients with mental illness in the future.

Mindfulness in Sexual Activity, Sexual Satisfaction and Erotic Fantasies in a Non-Clinical Sample.

The goal of this study is to better understand the relation between the practice of Mindfulness and the sexual activity, sexual satisfaction and erotic fantasies of Spanish-speaking participants. This research focuses on the comparison between people who practice Mindfulness versus naïve people, and explores the practice of Mindfulness and its relation with the following variables about sexuality: body awareness and bodily dissociation, personal sexual satisfaction, partner and relationship-related satisfaction, desire, subjective sexual arousal, genital arousal, orgasm, pain, attitudes towards sexual fantasies and types of sexual fantasies. The sample consisted of 106 selected adults, 32 men and 74 women, who completed six measures on an online survey platform: (a) Mindfulness Attention Awareness Scale (MAAS), (b) Scale of Body Connection (SBC), (c) New Sexual Satisfaction Scale (NSSS), (d) Scale of Sexual Activity in Women (SSA-W) and Men (SSA-M), (e) Hurlbert Index of Sexual Fantasy (HISF), (f) Wilson's Sex Fantasy Questionnaire. In the MAAS, Body Awareness subscale (SBC), NSSS, SSA-W and SSA-M, HISF and intimate fantasies subscale (Wilson's questionnaire), people in the Mindfulness condition showed higher scores and these differences were statistically significant. These results may have relevant implications in the sexuality of clinical and non-clinical samples.

Expert consensus on information sheet proposals for patients under treatment with lithium. / Consenso de expertos sobre propuestas de información al paciente en tratamiento con sales de litio.

INTRODUCTION: Lithium is one of the first therapeutic options for bipolar disorder, which is characterized by recurrent mood swings that strongly reduce quality of life. Our purpose was to achieve professional consensus criteria to define the contents of an information sheet for patients with bipolar disorder that are starting treatment with lithium. MATERIAL AND METHODS: A modified Delphi method in two rounds was used. The Scientific Committee-made up by nine psychiatrists-created a 20-item questionnaire about the information that must be given to the patient treated with lithium and selected a panel of ambulatory and hospital psychiatric experts to agree on this information. Panelists scored each item based on a Likert scale of 9 points and could add comments in a confidential manner. It was considered consensus in agreement when median scores were within the range of [7-9] and in disagreement within the range of [1-3]. RESULTS: A high level of consensus was reached. In the first round, there was agreement on 17 out of 20 items and, after the second round, there was disagreement on just one item containing information about the discovery of lithium. Finally, said item was modified in the Patient's Information Sheet based on the comments suggested by the panelists. CONCLUSIONS: This study allowed to create an information sheet for patients with bipolar disorder under treatment with lithium, with information agreed upon by a group of experts from different health care settings.

Ecstasy (MDMA): A rebellion coherent with the system.

Aim: This study attempts to demonstrate the relevance of the socio-cultural model of drugs in explaining the impressive development of ecstasy in the last 45 years. Method: First the study describes the use of ecstasy by groups which have left their imprint on the substance: university students, gays, yuppies and the "New Age" movement. Then the link between ecstasy and techno music led to the socially integrated "club" phenomenon, and the "rave", which began as a rupturing, nonconformist phenomenon. Findings: According to this argument, in spite of its clearly counterculture beginnings, the "rave" movement and its most characteristic drug, ecstasy, have gradually become integrated into mainstream culture, somehow reinforcing the functioning of capitalist postmodernity. Our study explains ecstasy's history in reference to the cultural contradictions of capitalism and the functions that it currently fulfils for young people. Based on this analysis, the implications of the cultural perspective are discussed as a paradigm of research in drug use, stressing notions of subculture, myths and rituals. It also proposes a harmonious articulation of academic and common knowledge as the most appropriate method for their study. Conclusion: A cultural approach to drug use could assist in unblocking a field so in need of conceptual and empirical revision.

Disordered Eating Attitudes, Anxiety, Self-Esteem and Perfectionism in Young Athletes and Non-Athletes.

Eating disorders are associated with short and long-term consequences that can affect sports performance. The purposes of this study were to investigate whether female athletes, particularly gymnasts and footballers, exhibit more eating problems compared to female non-athletes, and to identify individual personality characteristics including anxiety, self-esteem, and perfectionism as possible contributors to eating disorder risk. In a sample of 120 participants, 80 adolescent female athletes were compared to a control condition of 40 non-athletes (mean age 17.2 ± 2.82). Participants responded to a questionnaire package to investigate the presence of disordered eating (SCOFF) and psychological variables in relation to disordered eating symptoms or eating disorder status. Subsequently, anthropometric measures were obtained individually by trained staff. There were statistically significant differences between conditions. One of the most important results was the score in SCOFF (Mann-Whitney = 604, p < 0.05; Cohen's d = 0.52, r = 0.25), being higher in control than in the gymnast condition. These results suggest that non-athlete female adolescents show more disturbed eating behaviours and thoughts than female adolescents from aesthetic sport modalities and, therefore, may have an enhanced risk of developing clinical eating disorders.

Influencia De Los Estilos De Afrontamiento Sobre La Satisfacción Vital De Pacientes En Tratamiento De Hemodiálisis Y Con Trasplante Renal / Influence Of Coping Styles On Vital Satisfaction Of Patients On Hemodialysis Treatment And Renal Transplantation

Resumen Objetivo : Investigar la relación entre estilos de afrontamiento y niveles de satisfacción vital de pacientes en tratamiento con hemodiálisis y de pacientes con trasplante renal. Material y métodos: Treinta y cuatro pacientes en hemodiálisis tomaron parte del estudio, además de veintiuno en trasplante renal y cincuenta que no padecían ninguna enfermedad crónica. Se les administró la Escala de Satisfacción con la Vida (SWLS) y el Cuestionario de Afrontamiento al Estrés (CAEPO). Se comprobó que existían diferencias significativas entre los grupos con las variables estudiadas y se examinó la capacidad predictiva de los estilos de afrontamiento sobre la satisfacción vital para cada uno de los grupos que tomaron parte en la investigación. Resultados: Los pacientes en hemodiálisis presentaron una satisfacción vital significativamente menor que los participantes del grupo control. No existió diferencia entre los grupos clínicos, ni entre el grupo de pacientes trasplantados, ni en el grupo control ecn lo que se refiere a la satisfacción vital. En términos generales, los estilos de afrontamiento activos evitativo. Conclusiones: La coexistencia de estilos de afrontamiento activos y evitativos, en los que un moderado nivel de negación es acompañado por actitudes predicen positivamente el nivel de satisfacción vital, pero la misma se incrementa en los pacientes con hemodiálisis si además existe algún tipo de estilo de afrontamiento optimistas, eleva el grado de satisfacción vital de los pacientes con injuria renal crónica en hemodiálisis.

Abstract Objective : To investigate the relationship between coping styles and levels of life satisfaction of patients undergoing hemodialysis and patients with renal transplantation. Methods: Thirty four patients on hemodialysis, twenty one patients with renal transplantation and fifty who did not suffer from any chronic disease took part in the study. They were administered a Life Satisfaction Scale and a Stress Coping Questionnaire. It was checked whether there were significant differences between the groups in the variables studied. Additionally, the predictive capacity of coping styles on life satisfaction for SV of each of the groups that participated in the research was examined. Results: Patients on the hemodialysis group have a significantly lower SV than the participants in the control group, there being no difference between the clinical groups or between the group of transplanted patients and the control group as regards the SV. In general terms, active EAs predict positively the level of SV; but SV increases for hemodialysis patients if there is also some type of avoidant AD. Conclusions: The coexistence of active and avoidance coping styles, in which a moderate level of denial is accompanied by optimistic attitudes, raises the degree of vital satisfaction of hemodialysis patients.

The Influence of Coping and Personality Styles on Satisfaction with Life in Patients with Chronic Kidney Disease.

The objective of this ex post facto study was to find out how different coping and personality styles influence satisfaction with life in a group of 55 people with chronic kidney disease, 34 of whom were receiving haemodialysis and 21 had undergone a kidney transplant. The participants completed three questionnaires, the SWLS, CAEPO and MIPS. The results showed the relationship between active coping strategies and satisfaction with life in haemodialysis patients, kidney transplant recipients and the total sample. A Pleasure-Enhancing personality style was significantly related to Satisfaction with Life, both in the total sample, and in the two groups separately. There were no significant differences in Satisfaction with Life between the haemodialysis patients and kidney transplant recipients. The theoretical repercussions of these results are discussed, highlighting their applications to clinical practice, in which training in active coping is essential.

Understanding social withdrawal in euthymic bipolar patients: The role of stigma.

Social withdrawal acts as a risk factor in mental health, disturbing clinical management and quality of life in euthymic bipolar patients. However, no previous study has analyzed what variables might predict it. We conducted a cross-sectional study in which 49 euthymic bipolar patients were assessed. The analysis showed that taken together, stereotype endorsement, discrimination experience and control over illness as measured by the ISMI, together explained 80.4% of the variability in social withdrawal. In conclusion, an early assessment of self-stigma and perception of control over illness would help euthymic patients to improve their social situation, reducing social withdrawal.

Management of asenapine treatment in clinical practice: Recommendations from a panel of experts. / Uso de asenapina en la práctica clínica: recomendaciones de un panel de expertos.

INTRODUCTION: The choice of an antipsychotic should be based on bipolar disorder (BD) symptoms and the particular needs of each patient, as well as the adverse events potentially associated with treatment. Asenapine is an atypical antipsychotic indicated for the management of type-I BD, with distinct pharmacokinetic and receptor affinity profiles. MATERIAL AND METHODS: Recommendations document developed by a panel of experts with extensive experience in the use of asenapine in psychiatric care, including emergency department, hospital, and outpatient care. Recommendations were discussed in a single meeting and were based on both the clinical experience of the panel of experts and the empirical evidence provided in the scientific literature. RESULTS: The present document describes the patient profile that best suits the pharmacodynamic characteristics of asenapine, as well as the advantages and limitations of the pharmacokinetics associated with the sublingual route. The document also addresses the main safety issues of asenapine and suggests interventions aimed at mitigating the most frequent adverse reactions associated with asenapine treatment. Finally, the article provides advice on dosing and overall management of asenapine treatment, including the combination with other treatments and the switch from other antipsychotics to asenapine. CONCLUSIONS: In this recommendations document, we provide clinicians with guidance on the use of asenapine in real-life practice, including the identification of patients who best suit the characteristics of this antipsychotic.

A Review of Asenapine in the Treatment of Bipolar Disorder.

Bipolar disorder places a significant burden on the affected individuals, their family, healthcare systems and the overall economy. More treatment options are needed, especially those with better efficacy and tolerability. Asenapine is a second-generation antipsychotic approved in Europe (brand name Sycrest®) for the treatment of moderate-to-severe manic episodes associated with bipolar I disorder in adults, and in the US (brand name Saphris®) for the treatment of manic or mixed episodes of bipolar I disorder in adults and children aged 10-17 years. It is the antagonistic activity at the D2 receptor that is likely responsible for the antimanic properties of asenapine. Clinical trials have demonstrated that asenapine mono- and add-on therapy is effective in the short- and long-term treatment of mania associated with bipolar I disorder in adult and paediatric patients. In addition, post hoc and pooled data analyses have shown that asenapine is effective in reducing clinically significant depressive symptoms in patients with bipolar I disorder. The most common adverse events associated with asenapine are somnolence, dizziness, extrapyramidal symptoms, increased bodyweight and oral hypoesthesia. However, the incidence of these events, particularly weight gain, is generally lower than with olanzapine. In one study, asenapine has been shown to improve health-related quality of life. Economic analyses indicate that the use of asenapine can, over time, lead to a reduction in the costs of treatment.

[Acute lithium poisoning: epidemiology, clinical characteristics, and treatment]. / Epidemiología, características clínicas y tratamiento de la intoxicación aguda por litio.

Lithium continues to be the treatment of choice for bipolar disorder. Acute lithium poisoning is a potentially serious event. We present a retrospective observational significative study of episodes of acute lithium poisoning during a 52- month period. Poisoning was defined by a blood lithium concentration of 1.5 mEq/L or higher. We analyzed treatment and epidemiologic and clinical characteristics of 70 episodes were identified (incidence density among treated patients, 1.76 per 100 patient-years). The most frequent cause of lithium poisoning was a concurrent medical condition (46%). Most poisonings were mild (74.2%), but neurologic involvement was identified in 40.3%. Electrocardiographic abnormalities were found in 8 cases. Acute renal failure, found in 23 patients (37.1%), was mild in most cases, although 11 patients required hemodialysis. We concluded that acute lithium poisoning is an uncommon complication, but risk needs to be lowered. Patients should be warned to avoid dosage errors and to take special care during concurrent illnesses and while taking other medications.

El litio sigue siendo el tratamiento de elección en el trastorno bipolar. La intoxicación aguda por litio (IAL) es un cuadro potencialmente grave. Se presenta un estudio observacional, retrospectivo de las IAL observadas durante un periodo de 52 meses. Se definió como IAL cuando se registró una concentración de litio en sangre 1,5 mEq/L. Se analizaron sus características clínicas, epidemiológicas y su tratamiento de 70 episodios de IAL (densidad de incidencia: 1,76 IAL por cada 100 pacientes tratados-año). La causa más frecuente de IAL fue un proceso patológico intercurrente (46%). La mayoría fueron de carácter leve (74,2 %), con sintomatología neurológica en el 40,3%. En 8 IAL hubo alteraciones electrocardiográficas, 23 IAL (37,1%) se asociaron con fracaso renal agudo, la mayoría de carácter leve y 11 precisaron hemodiálisis. Se concluye que la IAL es una complicación infrecuente, pero es necesario disminuir su riesgo advirtiendo al paciente ante la existencia de procesos intercurrentes, errores en la posología o polimedicación.